Investigation and anomaly in urinary tract infection in children

 Despite  the  high  morbidity  of  the  complication  in  the  urinary  tract  infection  in  children  there  remains  considerable  controversy over  how  best  to  inestigate  these  children.  This  study  was  carried  out  to  see  the  relationship  of  the  anomaly  in  urinary  system  and  the  risk  factor  that  found  in  children  with  urinary  tract  infection.  One  hundred  and  seventy  six  children  with  urinary  tract  infection  was  investigated  by  radiology  examination.  The  anomaly  of  the  urinary  system  were  found  in  68  children  (38.63%) There  were  444  boys  and  24  girls.  Sixty  one  percent  of  the  anomaly  were  found  in  children  children  under  five  years  of  age.  The  stone,  hydronephrosis,  hydroureter  and  caliectasis  were  found  respectively. However  we  found  that  there  is  low  prevalence  of  the  anomaly  in  the  girls  over  two  years  of  age  with  lower tract  infection (low  risk  group)  but  there  is  no  statistical  correlation  between  the  risk  factor  and  the  anomaly  in  urinary  system.  This  suggests  that  we  should   be  investigated  for  anomaly  in  every  cases  of children  with  urinary  tract  infection.

Achievement in Personality and Ethics Development 2nd year medical student, 1994 Academic year.

Objective1. To establish and develop personality in order  to promote good leadership and  remember the essential merit and that correlate to the social needs of students.2. To build up and create appropriate values in Thai society among the students themselves especially in terms of unity, affection and a sense of belonging to each other and to the Academic Institute.3. To develop the student in terms of Social, Emotional \& Moral behaviour so that they can adapt to the new society.4. Build up the sensitivity and responsibility of students to society and to the country after graduation5. To promote in Medical students and supervisors a better relationship which will lead to trust and consultationMethods: The students were asked to attend the camp and advisers encouraged to understand their role so that they had ability to extend group relations. After this the students attended a 2 day and 2 night camp with various activities. Each group had 1-2 supervisors for group relationship activities using games as a medium by which to present social situations and human behavioral analysis. There was a video show about development, community life, leadership and human relations. There were group planning conferences, project planning activities, self and family development group presentations and other activities. Assessment by collective observation and the use of questionnaires showed that the target objectives were achieved. As a result of the course students personalities were developed to produce good leaders as well as producing good team member of society. Good ethical beliefs were fostered as was the aim of  being a worthy member of society. The right values of affection, good person to person relations a pride in the institute, adaptation to the school environment and to colleagues were achieved. A feeling of responsibility to society and to the Nation together with the promotion of relationships both to students and supervisors was established. The recommendation from students and participating supervisors is that it should be extended from 2 days and 2 nights to be 3 says and 2 nights by using a weekday and weekend or only the former which means doing the course after the students finish their exam. The location should be nor too far away from University. It should have a wide-enough conference room that suits various activities, a yard or sports ground that is suitable for physical or moral exercise of the students and nearby accommodation with an adequate restroom. Food should be arranged for everyone. This could be used by 3 rd year medical students so that they could prepare themselves for the clinical year. The assessment should be carries out regularly so as to improve weak points and become Faculty’s policy in the following academic year by training the 1st or 3rs year medical student and applying the formula that has been practiced by the 2 nd year medical student for the 2 st year medical student. Furthermore, the formula arranged for clinical year students to be demonstrates in the 3 rd year to medical students before they start their 4 th year. Subsequently it should be distributes so as to be part of the University plan.

Achievement in Personality and Ethics Development 1st year medical student, 1994 Academic year.

Objective1. To establish and develop personality in order to promote good leadership and member the essential merit and ethics that correlate to the social needs of students.2. To build up and create appropriate values in Thai society among the students themselves especially in terms of unity, affection and a sense of belonging to each other and to the Academic Institute.3. To develop the students in terms of Social, Emotional \& Moral behaviour so that they can adapt to the new society.4. Build up the sensitivity and responsibility of students society and to the country after graduation.Methods – Assigning the students to attend the 2 night camp,s activities.  There was an Analysis lecture of the present situation, social problems and human behaviour.  There was a video show about the Developemtn trends or the ‘new life’ Community Development.  Example of development experiences, leadership and human relations were raised.  There was a planning group meeting, arranging a project, self and family development activities,  The proposal of group and other activities from evaluation by collective observations, interviews and questionaires.  It has been found that to accomplish the target object.  The students program needed to be supplemented \& develop in order to get better personality, leadership and member, good merit \& ethics in society.  Appropriate values had to be emphasized such as unity, affection, relationships with one another, a price in the institute, adaptation to colleaques and the environment.  These values also include the feeling of responsibility for society that effect the entire country in the future. The recommendation from students and lecturers who attended this program is that it should have there activities for the 2 nd year and the 3 rd year students and there should be a chane of locations for demonstration.  The suggested place should be within a walking distance to the campus and provide proper accommodation and a conference room.  Interesting \& effective media should be used.  There main meals should be arranged and the light meal or snack could be reduced.  Public relations procedure should be advertised throughroughly and lecturers should participate in the activities, The evaluation should be done regularly so as to adjust and improve the weak points and consequently become the faculty policy Further more.  The academic program should include the merit and ethical teaching and the supplementary activities should be continuously administered until graduation.

Assessment of Total Body Water in Children

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Screening Test for Infection in Childern with SLE by C – reactive Protein Level

Background :  Infections  are  common  in  children  with  systemic  lupus  erythematosus  (SLE)  due  to  the  disease  itself  and/or  the  treatment  of  SLE  with  immunosup – pressants.  Notwithstanding.  These  infections  may  be  difficult  to  differentiate  from  reactivation  of  SLE  C – reactive  protein  (C-RP) is  a  rapid  and  direct  indicator  for  acute  phase  reaction.  Therefore,  C – RP may  be  useful  for  early  detection  of  and  infections  condition  in  children  with  SLE.Objective : To  detect  the  cut – off  point  of  a  c – RP  level  for  early  detection  of  an  infectious  condition   among  SLE  patients  and  to  evaluate  the  sensitivity,  specificity,  positive  and  negative  predictive  values  for  the  selected  C – RPDesign : Prospective  study  (diagnostic  test)Setting  :  Srinagarind  HospitalMeasurements  :  C – RP  levels  in  SLE  patients  with  and  infectius  condition  and  those  with  a  non – infectious  condition.Results  :  228  samples  of  serum  from  33  patients  with  SLE  were  tested  for  the  C-RP  level  by  turbidimenter  during  March  1,2000 and  February 28,  2001. Intercurrent  infection  were  documented  in  41  episodes  (17.9%) of   those  patients.  At  a  C – RP  level  \>  6 mg/I,  the  sensittvity  and  specificity  to  detect  an  infection  was  100 and  94  percent,  respectively.  The  positive  and  negative  predictive  values  were  79  and 100 percent,  respectively.Conclusion :  The  C – RP  level  is  a  rapid  and  accurate  method  of  detecting  intercurrent  infections  in  children  with  SLE  patients.

Clinical and laboratory manifestations of SLE in children

Background: Some clinical presentations of systemic lupus erythematosus (SLE) in children are different from SLE in adults. Diversity of clinical manifestations in childtood SLE causes difficulty in diagnosis and delay in treatment. Those can cause permanent organ damage and death in these patients.Objective: To study clinical and laboratory manifestations  of childhood SLE.Design: Retrospective and descriptive studySetting: Srinagarind Hospital, Khon Kaen UniversitySubjects: Children with SLE, onset before the age of 15,wered attended at Srinagarind Hospital between  January 1, 1994 and January 31, 2003.Results: Medical records of 57 lupus children were reviewed. The female to male ratio was 13:1. The mean age at onset was 11.32 ± 2.51 (2.92 – 14.58) years and mean duration of follow-up was 38.19 ± 31.83 months. The common clinical manifestations of onset were mucocutaneous symptoms (73.7%), nephropathy (71.9%), constitutional symptoms (54.4%) and joint symptoms(54.4%). Median time from onset to diagnostic criteria completion was 3 (0 – 53) months. Laboratory manifestations included LE cell (59.1%), hemolytic anemia (52.6%), lymphopenia (47.3%), leucopenia (23.6%), thrombocytopenia (7.1%), antinuclear antibody (ANA) (83.6%), anti Sm (52.4%), anti ds DNA (46.7%) and low C3 (78.8%).Conclusions: Clinical manifestations of childhood SLE were diverse. Some patients need months to years to reach American college of Rheumatology Revised Criteria for the classification of SLE. Therefore, SLE should be considered in the differential diagnosis of children with multisystemic symptoms. Urinalysis, complete blood count, ANA and serum complement would be helpful to diagnose this disease.

Assessment of quantitative proteinuria by using the protein-creatinine ratio in random single urine sample in children

Background :  Measurement of proteinuria can be evaluated by many ways. The gold standard method is 24 hours urine collection for protein, but it is time consuming and requires multiple steps for a valid sample. So that the purpose of this study is to evaluate whether the protein to creatinine ratio in the spot morning urine sample is a reliable indicator of 24 hrs urine excretion and to evaluate cut off level for separate nephrotic and non-nephrotic range proteinuria, because of previous studies can not be concluded the absolute cut off point.   Each institute should be set its standard point because of different tools and collection procedures.Method : Descriptive diagnostic test in 83 children (45 nephrotic range  proteinuria and 38 non-nephrotic range proteinuria) , age group 2-15 years old who were  admited at  Srinagarind hospital between 1st January, 2003 to 31st  December,2003. Urine was collected by 24 hours urine start in the morning and spot morning urine was collected at 8.00 a.m. for evaluation of protein and creatinine. The blood samples were collected by venous puncture and evaluated for cholesterol, albumin, BUN and creatinine. Then the data was analysed by diagnostic test and plotted on ROC curve.Result : The result of the study revealed that protein to  creatinine ratio in single random urine was significantly correlated with 24 hour urinary protein value. The best cut off level is 2.0 yields a sensitivity of 82.2% (95% CI 0.71-0.93) and a specificity of 71.1% (95% CI 0.57-0.83)Conclusion : Protein to creatinine ratio in a single random urine in children is a clinically useful screening test to differentiate nephrotic range  proteinuria from non-nephrotic range proteinuria by using the cut off point of 2.0 . For higher sensitivity and specificity, there should be further studies with larger  sample size.